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Type of recurrence is associated with disease-free survival after salvage surgery for locally recurrent rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

To compare the characteristics and outcomes of rectal cancer patients with local recurrence at a perianastomotic site (PA), a surgical field (SF) site, or in lateral lymph nodes (LLN).

Methods

A total of 114 consecutive patients who underwent surgery for recurrent, non-metastatic rectal cancer at a single comprehensive cancer center between 1997 and 2012 were grouped on the basis of radiographic assessment of type of recurrence: PA, 76 (67%) patients; SF, 25 (22%) patients; LLN, 13 (11%) patients. Demographic, clinical, and pathological features were compared between the three groups, as were disease-free survival (DFS) and overall survival (OS).

Results

Recurrence type was associated with positive circumferential margin in the primary resection (PA, 4 [6%]; SF, 4 [19%]; LLN, 3 [25%]; P = 0.027), prior neoadjuvant therapy for the primary tumor (PA, 57 [75%]; SF, 18 [72%]; LLN, 4 [31%]; P = 0.007), and location of the primary tumor in the upper rectum (PA, 33 [45%]; SF, 5 [23%]; LLN, 1 [8%]; P < 0.001). Patients with PA had longer median DFS (PA, 5.1 years; SF, 1.5 years; LLN, 1.2 years; P = 0.036). There was a non-significant trend toward longer OS and higher rates of R0 resection for PA.

Conclusion

Type of recurrence after salvage surgery for locally recurrent rectal cancer is associated with longer DFS in patients with PA recurrence.

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Acknowledgements

We gratefully acknowledge Minghe Wang, Bryan D. Loh, Kun Cao, Gerd R. Silberhumer, and Sanjun Cai for their contributions to this study.

Funding

This study was funded in part by the NIH/NCI Memorial Sloan Kettering Cancer Center Support Grant P30 CA008748. Jonathan B. Yuval’s research fellowship at Memorial Sloan Kettering was funded in part by grant T32 CA009501 from the National Cancer Institute.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA

    Rosa M. Jimenez-Rodriguez, Jonathan B. Yuval, Charles-Etienne Gabriel Sauve, Isaac Wasserman, Piyush Aggarwal, Jose G. Guillem, Martin R. Weiser, Iris H. Wei, Maria Widmar, Garrett M. Nash, Emmanouil P. Pappou, Julio Garcia-Aguilar, Philip B. Paty & J. Joshua Smith

  2. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA

    Paul B. Romesser & Christopher H. Crane

  3. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA

    Rona Yaeger & Andrea Cercek

  4. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA

    Marc J. Gollub

Authors
  1. Rosa M. Jimenez-Rodriguez
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  2. Jonathan B. Yuval
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  3. Charles-Etienne Gabriel Sauve
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  4. Isaac Wasserman
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  5. Piyush Aggarwal
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  6. Paul B. Romesser
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  12. Iris H. Wei
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  13. Maria Widmar
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  14. Garrett M. Nash
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  15. Emmanouil P. Pappou
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  16. Julio Garcia-Aguilar
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  17. Marc J. Gollub
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  18. Philip B. Paty
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  19. J. Joshua Smith
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Corresponding authors

Correspondence to Philip B. Paty or J. Joshua Smith.

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Ethics approval

This study was approved by an institutional review board.

Conflict of interest

Dr. Romesser has research funding from and is a consultant for EMD Serono and has received travel support from Elekta. Dr. Garcia-Aguilar has received support from Medtronic, Johnson and Johnson, and Intuitive Surgical. Dr. Smith has served as a clinical advisor for Guardant Health, Inc.

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Previous presentation

2018 Annual Scientific Meeting of the American Society of Colon and Rectal Surgeons, May 19–23, 2018, Nashville, Tennessee.

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Jimenez-Rodriguez, R.M., Yuval, J.B., Sauve, CE.G. et al. Type of recurrence is associated with disease-free survival after salvage surgery for locally recurrent rectal cancer. Int J Colorectal Dis 36, 2603–2611 (2021). https://doi.org/10.1007/s00384-021-03998-4

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  • DOI: https://doi.org/10.1007/s00384-021-03998-4

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